Refugees often arrive in the United States (U.S.) with unmet health needs and significant barriers to care related to linguistic and cultural access. In particular, oral health problems have been identified as the most common health problem of newly arrived refugee children and second most common among refugee adults. Oral health disparities seen among U.S. populations are therefore also likely to be common among refugees and similar immigrant populations entering the U.S. From 1995 - 2005, 21,868 total refugees entered Massachusetts from an increasingly diverse array of countries, particularly in Africa. Most recent refugees from Africa in Massachusetts arrive with rudimentary English literacy skills. While low health literacy contributes significantly to poor oral health status in the U.S., its relationship with oral health status among refugees is unclear. In previous research, we have found that on arrival in the U.S., African refugees have less tooth decay than other refugees while still having high rates of other oral health problems such as gingivitis. Very little is known about how refugees'English literacy levels affect oral health status over time in the U.S. Lastly, it is unclear to what extent refugees'oral health problems improve, persist, or worsen once in the U.S. These findings and issues suggest the need to evaluate the impact of health literacy on oral health outcomes among refugees and immigrants. Therefore, the investigators propose to use mixed quantitative and qualitative methods in a cross-sectional study of newly arrived Somali refugees to determine the relationship between basic English language literacy and oral health status. They hypothesize that increased English literacy may lead to better oral health status independently of the adoption of Western cultural and social factors affecting oral health status, i.e. acculturation. The study will evaluate the impact of English functional health literacy on oral screening examination findings, experience with dental care, and perceptions and knowledge of other key factors that are known to impact on oral health status. Qualitative assessments will focus on experiences with resettlement, oral health, and literacy/education as well as the role of life stressors in determining oral health practices. Findings subsequently may be used to help design culturally acceptable preventive services and public health interventions directed at refugees and immigrants in the U.S. PUBLIC HEALTH RELEVANCE: No previous study has investigated the relationships between literacy, acculturation, and oral health clinical outcomes among refugees. This study represents an important opportunity to define these relationships and identify areas in which preventive oral health interventions may be directed. Preventive oral health interventions directed toward the growing immigrant and refugee populations in the U.S. will be important for reducing oral health disparities and their associated personal and societal costs for these communities and the larger U.S. population.